Medial Branch Radiofrequency Ablation

If you are suffering from chronic neck, mid-back, or low back that has not responded to conservative treatments, Dr. Gilthorpe may recommend a Medial Branch Radiofrequency Ablation (RFA), if you had successful diagnostic injections. This minimally invasive procedure targets the medial branch nerves responsible for transmitting pain from the facet joints, offering long-lasting relief for people who have not responded to other treatments.

 

What Is Medial Branch Radiofrequency Ablation?

Medial Branch Radiofrequency Ablation (RFA) is a procedure used to treat chronic pain stemming from the facet joints in your spine. Facet joints are the joints located between each vertebra in the spine that allow for flexibility and movement. They may degenerate with time, wear-and-tear, or other degenerative spine conditions.

RFA works by using heat generated from radiofrequency energy to "burn" or destroy the medial branch nerves. These nerves transmit pain signals from the facet joints to the brain. By disrupting these signals, RFA provides long-term pain relief.

 

Is Radiofrequency Ablation for Me?

Medial Branch Radiofrequency Ablation may be recommended if:

• You have neck, back, or mid-back pain that has lasted for several months.

• Conservative treatments such as medications, physical therapy, and injections have not provided sufficient relief.

• You have previously undergone a diagnostic medial branch block, and it successfully relieved your pain. This test confirms that your pain originates from the facet joints and that RFA may be effective.

• You are seeking long-term pain relief and want to avoid or delay surgery.

Consult with your doctor to determine if this procedure is appropriate for your condition.

 

What Are the Benefits of a Medial Branch Radiofrequency Ablation?

The primary benefits of RFA include:

• Long-term pain relief: Many patients experience relief lasting between 6 to 12 months, and sometimes longer.

• Improved mobility and function: By alleviating pain, you may experience improved mobility and function, allowing you to engage in daily activities more easily, with less discomfort.

• Non-surgical: RFA is a minimally invasive procedure that does not require the recovery time or risks associated with surgery.

• Quick recovery: Most patients experience little downtime and can resume normal activities soon after the procedure.

 

What Are the Risks?

While Medial Branch Radiofrequency Ablation is generally considered safe, there are potential risks, including:

• Temporary increase in pain: Some patients may experience increased pain or discomfort at the injection site shortly after the procedure.

• Bleeding: Rarely, bleeding may occur, especially in patients with bleeding disorders or those on blood thinners.

• Infection: There’s a very small risk of infection at the injection site.

• Nerve damage: While extremely rare, there is a risk of damaging nearby nerves.

• Headache: A headache can occur from the medications used.

• Allergic reaction: Although rare, some patients may experience an allergic reaction to the medications.

 

How Do I Prepare for the Radiofrequency Ablation?

Preparing for an RFA involves a few important steps:

• Please call and reschedule if you have an active infection

• Wear loose, comfortable clothing that allows easy access to your back or neck

• Inform Dr. Gilthorpe of the following:

  • Allergies, or medication sensitivities

  • IV contrast allergy or sensitivity; or kidney disease

  • If you have diabetes, especially if it’s difficult to control

  • If you take blood thinners (such as clopidogrel/ Plavix, ticagrelor/ Brilinta, apixaban/ Eliquis, warfarin/ Coumadin, rivaroxaban/ Xarelto, enoxaparin/ Lovenox, heparin, or others)

• Blood thinners will need to be held prior to your RFA if it is the neck (ie, cervical area)

  • Dr. Gilthorpe’s office will reach out to the prescribing physician to clearance to hold blood thinners

• Blood thinners do NOT need to be held prior to your RFA if it is the mid or lower back (ie, thoracic or lumbar area).

• Fasting is NOT necessary for injections completed in the clinic

• A driver is NOT necessary for injections completed in the clinic. However, if you have significant weakness after the injection (which is rare), you will need to avoid driving for 6 hours. In which case you will need to stay at the clinic, or arrange transportation.

 

What if my radiofrequency ablation is scheduled in the hospital?

Diagnostic medial branch blocks are typically scheduled in the clinic. In limited circumstances, they may be scheduled in a hospital or surgical center. If your DMBB is scheduled at a hospital:

• You need to fast (including food and water) after midnight, the night before

• A responsible adult needs to accompany you to drive after anesthesia.

• The hospital will contact you to: 

  • Give you an arrival time

  • Let you know if any preoperative testing is necessary prior to anesthesia

 

How Is a Radiofrequency Ablation Done?

An RFA typically takes 30 minutes, and is performed on an outpatient basis. Here’s what to expect:

1. Safety-Check: Your vitals will be checked and the procedure site will be confirmed.

2. Positioning: You will lay face down on an X-ray table. You may be asked to change into a gown if the area is not easily accessible.

3. Cleansing the area: The skin around the injection site will be cleaned with antiseptic to minimize the risk of infection.

4. Draping: A small drape with be placed over the area to maintain sterility

5. Fluoroscopy (X-ray guidance): Dr. Gilthorpe will use fluoroscopy, a type of real-time X-ray, to guide the needle into the epidural space.

6. Local anesthesia: A local anesthetic is used to numb the area where the injection will be given.

7. Procedure: Once the needle is correctly positioned, radiofrequency energy is delivered through the needle, creating heat that destroys the medial branch nerve’s ability to transmit pain signals.

8. Band aid: A band aid will be placed over the site.

9. Monitoring: After the injection, you will be observed for a short time to ensure there are no immediate complications.

 

Post-Procedure Care and Restrictions

After an epidural steroid injection, you can usually return to normal activities with a few precautions:

• Rest for the first 24 hours: Avoid strenuous activities or heavy lifting for about a day.

• Mild soreness at the injection site is common. Placing ice over the injection site for no more than 20 minutes at a time can help relieve this soreness.

• Steroid side effects: You may experience hot-flashes or flushing, mild headaches, or insomnia for a few days.

• Serious side effects are very rare

• But if you have any of the following, you should go to an Emergency Room.

• New weakness and numbness after the initial weakness and numbness wore off; or persistent weakness over 24 hours.

• Severe swelling, redness, or drainage at the procedure site.

• New urinary incontinence.

• High fever.

 

How Long will an Radiofrequency Ablation last? How Often Is It Done?

• Relief can begin within a few minutes, but usually takes a day or two, and full effects may take up to two weeks.

• The pain relief from Medial Branch Radiofrequency Ablation typically lasts 6 to 12 months. In some cases, the relief may last longer, especially if you combine the treatment with physical therapy and other pain management strategies. The medial branch nerves may regenerate over time, which could lead to a return of pain.

• RFA can be repeated if the pain returns. Since the nerves can grow back, many patients undergo RFA every 6 to 12 months. However, the frequency of the procedure depends on your individual response and how long the pain relief lasts for you.

 

Frequently Asked Questions (FAQs)

Q: How soon will I feel relief after the procedure?

A: Some patients experience relief within a few days, but it may take 1-3 weeks for the full effect to become apparent as the nerves are disrupted and the pain signals are blocked.

Q: How long will the pain relief last?

A: Pain relief from RFA typically lasts 6 to 12 months, but some patients may experience relief for even longer.

Q: Is the procedure painful?

A: You may feel some discomfort during the procedure, but a local anesthetic is used to numb the area. Some patients experience mild soreness afterward, but this typically resolves within a few days.

Q: What if the pain comes back?

A: If the pain returns after the nerves regenerate, the procedure can be repeated. Your doctor will evaluate your condition to determine when it’s appropriate to perform another RFA.

Q: Can I combine RFA with other treatments?

A: Yes, RFA can be combined with other treatments such as physical therapy, medications, and lifestyle modifications to enhance the results and manage your pain more effectively.

Q: Will I need to take time off work?

A: Most patients can return to work and normal activities within a few days of the procedure. However, if your job involves heavy physical activity, you may need to take additional time off to recover.

 

Conclusion

Medial Branch Radiofrequency Ablation is a safe, effective treatment for chronic back and neck pain caused by facet joint issues. By targeting the medial branch nerves, this procedure offers long-term relief and improved quality of life without the need for surgery. If you’re struggling with chronic pain and want to explore your options, speak with your doctor to see if RFA is the right treatment for you.

For more information or to schedule a consultation, [request an appointment here] or call us at 832-286-4546.